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The Department's director of access wrote to all PCT chief executives in July 2005. The letter stated that referrals to community-based clinical assessment services and other such centres should happen only where that adds genuine clinical value for patients.
How on earth can it make sense for GPs who have not seen the patient to be paid £60 an hour to second-guess and vet the referral letters of GPs who have seen the patient and who know their patients? How can it make sense for every referral letter from every GP in Oxfordshire to be sent to some central lubyanka in the middle of Oxford in some Stalinist process to be second-guessed? What on earth does that say about the system's confidence in GPs to make appropriate referrals and the integrity of GP commissioning?
The hon. Gentleman opened his question with the phrase, "How on earth". He must be on a different planet, because the description that he just gave is not what I recognise. If he is referring to the concerns that the British Medical Association has raised recently, I should say that even the BMA acknowledges that there is real benefit to be had in a different way of managing referrals, so that the patient goes to the person whom they need, depending on the nature of their complaint.